AUA (American Urological Association)

Introduction & Objectives: Circumferential substitution urethral surgery by neotubes is declined and the new trend is urethral augmentation with graft of buccal mucosa (GBM).

Material & Methods: Patient, 25 years old, with bulbar stenosis > 2 cm.  The urethra is opened ventrally in the midline over the stricture. The urethral plate is laid open for 1 cm both proximally and distally into the healthy urethra. The exposed dorsal urethra is incised in the midline up to the tunica albuginea. The margins of the incised dorsal urethra are dissected from the tunica and an elliptical raw area 2 cm long is created over the tunica albuginea. GBM harvesting from the cheek: the graft 6 cm long is divided in two smaller grafts, respectively 2 and 4 cm long.

GBM 2 cm long is placed dorsal inlay in the recipient elliptical area, sutured to the urethral margins and quilted to the tunica with interrupted stitches. Subsequentely, the urethra is augmented by the ventral onlay GBM 4 cm long that is anastomosed to the margins of the urethral plate. The spongiosum is closed over the graft.

We used this technique to enlarge the urethra better in tight strictures with narrow residual urethral plate in which only one patch was not suitable to make a wide enough lumen.

Results: After 1 month the catheter was removed and the cistourethrography showed  a regular urethra.

Conclusions: By saving the urethral plate, the dorsal and ventral contemporary urethral augmentation aims to reduce the risk of recurrence in tight stricture repairs.